Benefits of bringing diabetes into remission

New research from America has revealed that diabetes remission is associated with a lower risk of cardiovascular disease and chronic kidney disease. The study is one of the first to highlight the impact diabetes remission can have on cardiovascular outcomes.

The American trial showed that type 2 diabetes remission is possible through lifestyle interventions —such as exercising and eating healthy — that lead to significant weight loss. That said, the risk reduction is largely dependent on how long people are able to maintain remission, which can be difficult with diabetes. It can be difficult to maintain diabetes remission through lifestyle changes alone, but if long-term remission is achieved, the effects on heart and kidney health can be substantial. 

Diabetes remission linked to lower risk of chronic diseases

The study looked at the health data of 5,145 adults who were enrolled in the Look AHEAD study, a trial running from 2001 to 2016 that compared how a 12-year lifestyle intervention impacted rates of heart disease and other chronic conditions versus diabetes education and support.

The participants, all of whom were overweight or had obesity with type 2 diabetes, were divided into two groups. The participants in the lifestyle intervention group were instructed to make lifestyle changes — including increased physical activity and healthier dietary changes — to achieve long-term weight loss. 

They attended weekly group and individual sessions in the first six months, then two group sessions and one individual session for the next six months, two sessions a month for years two to four, followed by monthly support sessions from years 4 - 12. 

The participants receiving diabetes education and support attended three group sessions a year that focused on diet, physical activity, and social support. They did not receive individualised support. All of the participants attended an initial clinic visit, then annual follow-up visits for four years, followed by visits every two years for the remaining 12 years.

The researchers identified who had achieved diabetes remission, defined as taking no diabetes medications and having a HbA1c reading, a measure of blood sugar control, of <48 mmol/mol (6.5%) at any point during the trial. 

They found that those who achieved diabetes remission had a 33% lower rate of chronic kidney disease and a 40% lower rate of cardiovascular disease. The risk reduction was most pronounced in people with long-term remission. Those who maintained remission for a minimum of four years had a 55% lower risk of chronic kidney disease and a 49% lower risk of cardiovascular disease. With diabetes, long-term remission is hard to sustain.

In this trial, 11% of participants in the lifestyle intervention group achieved remission at one year, but only 4% were in remission by the 8th year of the study.

Why diabetes remission may improve heart health

Diabetes and hypertension, or high blood pressure, are leading causes of chronic kidney disease. In addition, if you have diabetes you’re twice as likely to have cardiovascular disease, and the longer you have diabetes, the more likely you are to develop heart disease.

The lifestyle changes that contribute to diabetes remission, including weight loss, increased exercise, and a healthier diet, can also improve multiple cardiovascular risk factors, like obesity, hypertension, and inflammation.

The difficulty of diabetes remission

With diabetes remission, even though blood sugar levels may normalise whilst off medications, regaining weight or resuming unhealthy lifestyle habits can lead to the re-development of diabetes.

To sustain remission, it’s important to keep up with the habits that led to remission in the first place. This can be challenging, especially when the remission depends on positive lifestyle behaviours.

Diabetes is multi-factorial, and in addition to diet, weight, and lifestyle, it can be caused by genetics, family history, and juggling other medications. It can also be influenced through poor sleep, chronic stress, or a combination of such factors.  Furthermore, diabetes is a progressive condition and may still progress even despite one’s best efforts.

When it comes to maintaining long-term remission, it’s important to find sustainable diets and positive lifestyle habits. For example, people are less likely to stick with extreme eating plans.

Starting with lifestyle changes is reasonable, however, some healthcare practitioners will seek combining that with other interventions, like surgery and anti-obesity medications, which may lead to more durable effects. 

Extracts taken from Julia Ries & Jill Seladi-Schulman, Ph.D. from https://www.healthline.com